SINCE coming to power the government has proposed sweeping reforms to the NHS. David Cameron argued that Britain had fallen behind other EU countries and that there was ‘little incentive in the NHS to improve the health of the nation’. The proposals put forward by the Health Secretary Andrew Lansley would see a radical shake up of the NHS and its management, by allowing hospitals, private healthcare and family doctors to compete for patients, and GP consortiums taking control of 80% of the NHS budget. Although the reforms are set to get rid of 152 Primary Care Trusts and save the tax payer more than £10bn over the next decade, they have been met with waves of criticism. Doctors and experts have argued that it is too early for these reforms and that 24,000 jobs are now at risk. Is this the end of our great institution? And has the government taken out the ‘National’ in our NHS? Or are these reforms a necessity to curb the waste that has impoverished the system for years and bring private-sector standards of efficiency to a poorly run bureaucracy? >>

1. Britain is way off the pace

BY THE standards of other European countries, and by some measures, David Cameron’s comments that the NHS provides care which is “second-rate” are persuasive. Cancer survival and stroke recovery rates in particular are not on par with a country as wealthy and developed as ours. It’s not just a question of money, either. During 13 years of Labour rule, billions of pounds were ploughed into the NHS to bring per capita health expenditure back into line with other OECD nations. But all that cash saw little of the improvement in productivity and quality that should have been expected. Why? Among other reasons the NHS, like other public-sector monopolies, tends to be run in the interests of the people who work in it rather than those who use it. There’s no real competition, so no real incentive. Britain lags behind other advanced industrialised nations. And if money isn’t the fix, then changing the system itself must be.

2. Monopoly Bad. Market Good

ECONOMISTS have a nervy term for this: Creative Destruction. Despite the financial crisis exposing the shortfalls of an unfettered market, the fact remains that in the political world there is a noticeable commitment to the virtues of private enterprise and competition. The Private Finance Initiative was born in the UK and is copied in virtually every country. Bringing private sector standards of accountability to the public sector works for everyone. Private businesses foster an environment of competition as the improvement of resources and facilities allow companies compete for “business”. The injection of much-needed cash into the NHS is only a short-term solution, to really improve healthcare standards we must reform the way the system is run.

3. Demographics mean the status quo is unsustainable

BRITAIN is seeing a demographic squeeze. The baby-boomers born after the Second World War are about to retire and place unprecedented demand on a system designed when there were significantly more workers for each retiree. To even begin to cope, “modernising the NHS”, as Lansley put it, “is a necessity, not an option. In order to meet the rising need in the future we need to make changes.” David Cameron, too, has emphasised that this is not a time for timid half-measures. In his RSA speech, he said: “Pretending that there is some easy option of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.” The key is planning ahead, pushing through bold reforms – while the Government has political capital to spend – and laying the groundwork for a time when more people than ever before will need regular health care, and only a system considerably more efficient than this one will be able to cope.

4. The reforms will make the NHS more efficient

THE NHS is a behemoth – the second largest employer in the world – and crippled with red tape, an obsession with targets and too many administrators at every stage of a patient’s contact. Documents released alongside the bill claim the cost of this £1.4bn overhaul would be paid off through savings within two years. The Impact Assessment estimates than with between 16,000 to 26,000 managerial jobs going, there could be savings of £5bn by 2015, and £12bn by 2020 – as well as improved health outcomes for patients. The NHS now operates in a climate of consumer expectations and impatience unthinkable in 1948. In Web 2.0 world where consumers expect immediacy an organisation with cumbersome bureaucracy can not be tolerated.

5. It’s not privatisation, it’s reform

SOME tend to see privatisation as an inherent evil and there’s been no shortage of shrieking about how this bill will see the destruction of the NHS and replaced with a privatised US-style system.This won’t happen. There will still be free health care. But instead, there is a restructuring, which brings the GP into the centre of the system along with the patient and private companies will be allowed to compete to do things better. Much of this opposition is the typical reaction of vested interests who fear a threat to the status quo. Cameron put it well: “The idea that all these changes amount to privatisation is simply not true… [we must] recognise what matters to the patient. And what matters to the public is, ‘Is there a good, free national health service, free to me at the point of use that’s giving me the operation I need, the care I need, the support I need?’”

1. It IS privatisation

The notion that GPs – who already have lots on their plate with patients – are going to happily spend their time in ‘consortia’, dealing with the commissioning of care, phoning hospitals etc, is ludicrous. This is already being borne out by early pilot programs. GPs are doing exactly what you would expect – they’re outsourcing it to for-profit private companies, whose interests are not the same as the patient’s. Critics have also questioned whether GPs have the experience and skills to handle such huge budgets – they will have control of about 80% of the NHS budget. Various GPs have voiced concerns about how care will be decided upon. Some think one danger is that consortia may decide that some of the more marginal services are not a priority for funding, and that local hospitals could be hit as private sector providers look to win more NHS contracts.

2. It’s expensive and difficult

Nobody knows much the reforms will cost. Figures range from £1.4bn to £3bn – and this huge expense is not even the biggest problem. It’s logistics. The whole reform seems predicated on the assumption that GPs are the right people to be running services in the NHS, which is by and large an untested theory. Maybe a small minority of them want to manage (and are capable of it) but many won’t. And these new consortia will be crucial to the reforms’ success. They’ll need support. All this will entail siginificant changes since these consortia will have to develop a whole range of specialist skills that currently exist only in the soon-defunct Primary Care Trusts (PCTs), including accounting, management, administration and budgetary controls. There will be redundancy packages, contracts wound up, buildings sold, consultants employed. And if that weren’t enough, the GP consortia will have to take on staff to do all this, many will be those just laid off by the PCTs.

3. The electorate will oppose it

There is worry in the Conservative party. As Nigel Lawson observed, “The NHS is a religion with a priesthood.” One current minister even confessed: “It [and not the cuts] is the thing that keeps me awake at night.” What’s more, it’s not like the electorate is massively dissatisfied with it, either. From 1997 to 2010, the percentage of people satisfied with the NHS went from 55 to 71 percent. Should opposition mobilise and persist, the risk is not only that the Coalition may struggle with the rest of its agenda, but that any alternative, more prudent reforms may be tarnished down the road. One senior minister is quoted in the Evening Standard as saying:“If [it] falls apart, we’re finished, and we’ll deserve to be.” It is a big risk meddling with something the British people believe is their birthright.

4. Something’s fishy here

This is pure ideology. Despite the recent chumminess of the Tories and the Lib Dems, and Cameron’s success in abandoning the “nasty party” moniker, it’s been forgotten than this is a Tory government and not the natural successor to New Labour after all. The electorate decided that Cameron could be “trusted” with the NHS, because of his family’s gratitude for the care their disabled son received. Yet some are concerned we’re now seeing the Conservatives’ true colours, their real agenda for a takeover of public services, without a mere hint of what was coming. On the back of a trebling of tuition fees, it is starting to look like part of a right-wing, upper class plan to take treasured entitlements away from the beleaguered middle classes and give them to the “Elite”. If this belief festers the reforms will fail.

5. The people who really know are opposed

Most health professionals are opposed, and they know better than any politician what works and what doesn’t. Karen Jennings, head of health at Unison, said: “This Titanic health bill threatens to sink our NHS. The only survivors will be the private health companies that are circling like sharks, waiting to move in and make a killing.” Professor Chris Ham, head of the King’s Fund think-tank, warned the changes were at risk from “the combination of the funding squeeze and the speed and scale of the reforms”. The Royal College of GPs, the British Medical Association (BMA) and trade unions say the upheaval is unnecessary. The heads of six health unions have warned of their “extreme concerns” about greater competition with private companies.

Government proposes inquiry into moving to a 'pay NHS'

Last week the government quietly announced a review into the biggest political hot potato of all - and almost no-one noticed.

Image: Parliament.gov.uk

Imagine for a moment that you are the newly re-elected Conservative Prime Minister, and you want to launch an inquiry into whether the NHS should be paid for in future through user charges and insurance, not through tax.But you’ve got a problem - you’ve just won an election without breathing a word that you were considering such a fundamental change to the funding of the NHS.So how would you make such an announcement?Very quietly, of course.Last week the government did just that.If David Cameron, or his Chancellor or Health Secretary had announced such an inquiry to re-consider a principle that has been sacrosanct since 1946, you’d expect front page headlines and Newsnight specials considering the implications. You’d expect a bit of a flurry (to say the least) about whether Cameron was back-tracking from his promises about what voters said was their number one issue.But the launch of this inquiry has not been reported in the mainstream media, at all.Why? Because it was casually announced by a little known minister, the newly ennobled “Under Secretary of State for NHS Productivity", Lord David Prior, in the rarefied atmosphere of a House of Lords debate on the “sustainability” of the NHS, moved on 9th July by crossbench peer Lord Patel.The principle of how the NHS is funded has (mostly) stood firm since 1946, summed up in clause 4 of its White Paper:“All the service, or any part of it, is to be available to everyone in England and Wales. The Bill imposes no limitations on availability – e.g. limitations based on financial means, age, sex, employment or vocation, area of residence, or insurance qualification.”That is, the NHS is available to everyone, whether or not they can afford to pay user charges, or whether they are insurable. The question about whether the NHS could be funded through user charges or insurance is answered here: No it shouldn't.But where better to have the sort of debate that no one has voted for, and launch an inquiry that no-one has voted for, than in the House of Lords, which no one has voted for?

Prior – recently elevated to the Lords from his stint as the strongly pro-market chair of the Care Quality Commission, formerly a Conservative MP and deputy party Chair – led for the government in the Lords debate.Before he seized the opportunity to push his agenda, he said he listened to the “strength of feeling” in the unelected House.Tory peers like Lord Cormack argued in favour of moving away from tax funding, saying:

"All forms of funding must be looked at. We have to have a plurality of funding if we are to have a sustainable NHS. Whether the extra funding comes from compulsory insurances or certain charges matters not, but it has to come.”Matters not!? As a true Tory, he says that the funding should not come from taxing the rich (which he does not even countenance), but instead from taxing the sick.

More disappointing were the contributions from Labour peers like (the notoriously pro-privatisation) Lord Warner:“Our tax-funded, largely free at the point of clinical need NHS is rapidly approaching an existential moment. The voices of dissent and outrage will no doubt be deafening but a wise Government should begin now the process of helping the public engage in a discourse about future funding of the NHS."Far from endorsing the tax-funded system that is widely acknowledged to be the fairest way of paying for healthcare, here we have Labour peers suggesting the government should "help" the public to think of other ways to pay for healthcare.Another Labour peer, Lord Desai, suggested bizarrely that patients should be issued with an "Oyster card" which is deducted whenever a patient uses healthcare, and patients should receive a "bill" at the end of the year, saying this would “help make it clear to people that a free National Health Service is not a costless one."Shades of Jeremy Hunt's daft suggestion to put the price on prescription medicines. But the problem with the NHS is not unnecessary demands, it is the sheer magnitude of people who need healthcare. An "NHS Oyster card" will not reduce the number of elderly people with acute co-morbidities. And if "consumer demand" is a problem, the solution is to turn patients back into patients rather than healthcare consumers, and remove the market.

Once their Lordships had had their say, Prior concluded for the government, saying that though he “personally” liked a tax-funded system,“if demand for healthcare outstrips growth in the economy for a prolonged period, of course that premise has to be questioned."And he announced the ‘way forward’:

"I would like to meet the noble Lord, Lord Patel, and maybe two or three others, to discuss this in more detail to see whether we can frame some kind of independent inquiry—I do not think that it needs to be a royal commission. We are not short of people who could look at this issue for us; there are health foundations, such as the Nuffield Trust and the King’s Fund.”Prior ignores the fact that the Kings Fund has already recently carried out an inquiry, the Barker Review, which rejected user charges and called instead for more taxes to pay for healthcare, in particular through a review of inheritance tax and national insurance increases. Both of which George Osborne has just cut, of course.So Prior orders another inquiry, this time using people he has chosen and presumably people who will produce the desired result. Such a fundamental inquiry should involve the public and be held in public, but it appears Prior does not want the public involved.Is Prior, in announcing an inquiry into so fundamental an issue, acting above his paygrade as an unelected junior health minister?And are we being nudged towards an inefficient, unfair ‘pay NHS’ in the only way possible – undemocratically?Like this piece? Please donate to OurNHS here to help keep us producing the NHS stories that matter. Thank you.Editors' note:We've been inundated with people asking how they can help fight this. We suggest contacting your MP and pointing out to them that the government health minister, Lord Prior, has just suggested to parliament that he plans to launch an inquiry to consider whether we should move away from a tax-funded NHS towards one funded by insurance and co-payments.Ask them (if they are a Conservative MP) or ask them to ask David Cameron in parliament (if they are not) whether it is now official government policy to consider such a move to an insurance or user-fee funded NHS, away from the core principles of the NHS that have been in place since 1946? You might also want to remind them that David Cameron said in 2011:'Let me make this clear - we will not be moving towards an insurance scheme, we will not introduce an American-style private system. In this country, we have this most wonderful, precious institution and idea. That whenever you're ill, however rich you are, you can walk into a hospital or surgery and get treated for free. No questions asked. No cash asked. I will never put that at risk.'And ask your friends to do the same!

A very interesting subject to broach. Personally I believe it would be an absolute disaster to privatize UK health care, nonetheless the NHS is in drastic need of a complete overhaul, something I can't see ever happening - where would you start? Without establishing yet another quango to oversee a complete change, at a cost which would partially defeat the object of the exercise, like all nationalized industries of latter days, they develop into huge ungovernable empires often losing sight of their original purpose.

The success of privatization I think would largely depend on how the system is administered. I presume that it would necessitate all citizens being covered by health insurance - a huge lucrative incentive for insurance companies and medics alike but no benefit to the sick. From my experience of health insurance, the companies love to take your money but they're not quite so willing to pay out + there are always hidden provisos that limit the amount payable against any one claim. Unless of course you're a millionaire then who cares anyway. Unless you can afford to opt for some complete package that might cover all aspects of health care (including such as dental care and therapies not officially recognized by health officials) then I fear many people would be unable to afford adequate cover and thus their health compromised - quite a common situation to be found across the globe.

I can see such a system creating a greater social divide, preventing certain sections of society from receiving unlimited health care. Again from experience, health care professionals (for want of a better word) in the private sector are primarily money oriented and overly nepotistic. Having been spoilt by the NHS facility for so many decades, I can't see that the move will ever be accepted by the populace. Not forgetting it spreads right across the board from hospital care, nursing care, visits to a GP or medical specialist, prescribed medication - it's endless.

As a point of interest, a couple of years ago the wife of a bloke I know living outside the UK was whisked off to a clinic under doctors orders (said doctor being the brother of the clinic specialist) for observation. Whilst in the clinic her condition deteriorated rapidly and within three weeks she sadly died. The couple weren't insured so the three week stay at the clinic cost the equivalent of approximately £20K. What average wage/salary earner can realistically afford astronomical insurance premiums or the direct cost of health care?

Tricky question.

ETA: The same woman some years prior had laser cataract surgery on one eye. She was told by the specialist (doctor slash surgeon affiliated with the clinic) that her other eye was developing a cataract which would need surgery in the near future. Up to the time she died there was no requirement for further surgery or any indication that it might be necessary.

____________________“ The secret of life is honesty and fair dealing. If you can fake that, you've got it made" - Groucho Marx

The problem with the NHS is that once it stops being best in class through under investment people start to go private and then have to pay twice - once through their taxes and again through healthcare insurance. Same with education if you don't like the state offering you can pay twice - once through taxes and again through school fees. When the wheels come off the state funded model they come off big time.

Thank you for the link, I'm always interested to hear the views of an insider so to speak.

I know my prior ramblings are not relevant to the outlined proposals for privatisation of the NHS but I can't really envisage a workable compromise of joint administration between the government representing the NHS and the private sector. IMO either the NHS must continue as it's now recognized (hopefully with a major overhaul) or be abolished and taken over by the private sector in entirety. Having said that, the government need to keep a foothold in the nations health care or gradually they'll be talking their way out of a job!

It would be a radical departure from the norm but how aboutasking the people what they want - like a referendum? I watched a video the other day of Tony Bennett being interviewed during which he touched on the subject of direct democracy, a very sucessful fair system operating in Switzerland. Apart from giving the people the opportunity to elect, we really have little or no say in the running of the country - it is our money they're spending isn't it?

ETA: I notice some bright spark suggests that the post war baby boom is largely responsible for all the pesky wrinklies who have the audacity to retire and benefit a little the money the government hasstolen from them over the years. No mention of the impact immigration must have on public resources - no of course not, that's within their direct control isn't it? Can't be seen to take responsibilty for a situation they've created can they?

I wonder how doctors Gerry and Kate McCann feel about this potentially lucrative proposal?

____________________“ The secret of life is honesty and fair dealing. If you can fake that, you've got it made" - Groucho Marx

@roy rovers wrote:The problem with the NHS is that once it stops being best in class through under investment people start to go private and then have to pay twice - once through their taxes and again through healthcare insurance. Same with education if you don't like the state offering you can pay twice - once through taxes and again through school fees. When the wheels come off the state funded model they come off big time.

This is true! Just to add another irrelevance - thousands of UK citizens who have elected to live abroad still pay UK taxes but reap none of the benefits, healthcare and schooling being good examples.

____________________“ The secret of life is honesty and fair dealing. If you can fake that, you've got it made" - Groucho Marx

NHS dentistry used to be free at the point of need. Now it is rationed with NHS dentists having to apply for funding. The work that they can do is limited by modern standards. I would expect the same thing to happen to the rest of the NHS over time.

I don't make a habit of signing petitions (mainly because they serve little purpose) but on this occasion I make an exception !

Is it not possible for NHS supporters (I imagine the majority of the population) to demand a referendum? Demand I know is a strong word which would be frowned upon but given the anticipated overwhelming support network for the NHS, is there any possibility of compromising the government?

ETA: Thanks to Get'emGoncalo for introducing the subject to the forum, a platform to spread the word.

____________________“ The secret of life is honesty and fair dealing. If you can fake that, you've got it made" - Groucho Marx

I feel for you Patrickjohn along with all colleagues, patients and citizens who see through the deceitful rhetoric of successive governments and are aware of the true situation, the agenda of corporate and personal greed and worship of Neo Liberal ideology. So many buy into the false narrative and are blind to what has been done to weaken and enable vilification of NHS and it's staff. This is a great tragedy for British citizens but like lambs to the slaughter many go along in ignorance.

Spreading the true story as far and wide as possible to wake people up is so important. My admiration goes to all staff but especially to those working tirelessly to halt the destruction of the precious and priceless NHS.

As well as Youssef El-Gingihy's book 'How to dismantle the National Health Service in 10 Easy Steps', there is a great more weighty book 'NHS For Sale Myths Lies and Deception.' by Jacky Davis, John Lister and David Wrigley.Jacky Davis was interviewed on Going Underground on RT on the July 22nd programme.

Thank you so much @Verdi for signing If only more people were aware of the government agenda. It's heartbreaking to watch what is happening to the NHS and so many other aspects of our society. Here is a brilliant political satire of our Daily Hate -Phone our hate line now!

Concerned ex pat wrote:I feel for you Patrickjohn along with all colleagues, patients and citizens who see through the deceitful rhetoric of successive governments and are aware of the true situation, the agenda of corporate and personal greed and worship of Neo Liberal ideology. So many buy into the false narrative and are blind to what has been done to weaken and enable vilification of NHS and it's staff. This is a great tragedy for British citizens but like lambs to the slaughter many go along in ignorance.

Spreading the true story as far and wide as possible to wake people up is so important. My admiration goes to all staff but especially to those working tirelessly to halt the destruction of the precious and priceless NHS.

As well as Youssef El-Gingihy's book 'How to dismantle the National Health Service in 10 Easy Steps', there is a great more weighty book 'NHS For Sale Myths Lies and Deception.' by Jacky Davis, John Lister and David Wrigley.Jacky Davis was interviewed on Going Underground on RT on the July 22nd programme.

@Patrickjohn wrote:Thank you so much @Verdi for signing If only more people were aware of the government agenda. It's heartbreaking to watch what is happening to the NHS and so many other aspects of our society. Here is a brilliant political satire of our Daily Hate -Phone our hate line now!

Appreciated but thanks are really not necessary - a worthy cause is always worth the extra effort.

The UK government is responsible for yet another monumental cock-up and yet again it's the citizens that pay the price. Frankly they make me sick the way they play with our lives without a moments thought for the repercussions - will they lose their livelihood or be affected by destruction of the NHS?No, I don't think so!

____________________“ The secret of life is honesty and fair dealing. If you can fake that, you've got it made" - Groucho Marx

My daughter and family live in Brisbane. Australia has an excellent NHS which is attracting our doctors over there in droves. Employment conditions for them are much better. It is NOT all due to the population living a healthy outdoor life. Oz has very cheap health insurance, not for better, or earlier treatment, or treatment by differently qualified people, but for what I should call hotel accommodation when you have to go into hospital. This is not 'posh' but you get a single room, and meals delivered, and a tele. The money from this is ploughed back into medical services across the board.

Australia's 5 year survival cancer results, and just about every other parameter you care to choose, are better than ours. Anyone can go to any GP anywhere. GPs, so to speak, 'tout for business', so they are friendly and polite. :-) Some tend to specialise in paediatrics, whilst doing all the general work as well. Some have a good name for looking after chronic illnesses in the elderly.

There seems to be NO prejudice against the old BTW. When the 'swine flu' epidemic hit a year or two back we in the UK had precisely nine heart-lung machine for life saving treatment of the most serious cases. We had to send one poor young pregnant woman to Scandinavia to be put on such a life saving lung function machine. Brisbane medical district alone had nine heart-lung machines for their use alone. I watched an interview with a woman who had benefitted from one of them. She was jolly, and frail-looking, but she was well into her seventies. Does anyone seriously think she would have got a look in over here?

There is according to my daughter no difference in the quality of medical care between 'private' and run-of-the-mill health service. She found hers excellent. She had her three children (for ideological reasons) on the straight NHS... with fourteen year old aborigine girls and people from the Torres Straits Islands in her ward. The middle classes mostly choose single rooms in a 'private' building rather than on wards, but on the same site, with the same medics. Afterwards she was asked to write a report about her experiences of the ordinary system, and asked if she was willing to attend discussion meetings, which she did. There was constant concern to improve services. She was impressed.That would be ONE way of raising money to improve our NHS services. I used to think no, that's two-tier, but I have changed my mind.

Most importantly she says she found a lack of medical arrogance, and a true attitude of partnership with patients: medics giving medical advice and assistance for the true benefit of the individual person in front of them, rather than claiming all problems are due to 'lifestyle choices', and so are really the patients' fault anyway. Preventive medicine was very good as far as she could see, and health education was important in schools. There was NO warbling on about saving the service money as dressings were grudgingly given out, as you get over here. 'Pardon me for living so long. I do realize that the cheapest patient is a dead one'.

Maybe my daughter had unusually good experiences with the Australian Health Service, but she's lived there for twelve years now, and I don't think so. Here we worship the idea of our NHS, and believe in a lot of ideology around it, but in many instances its results, and our experiences in using it are POOR, for structural reasons. That is not to say a great many individuals within the system are excellent and committed professionals, as good as you would find anywhere.

Interesting post, thank you. I believe the NHS here is all but privately run already. I think the confusion arises because people equate private with getting a bill or worse, no cash, no treatment. Here private contractors are able to tender for services along with the trusts and are frequently being picked over the traditional provider. I know of a hospital where costs for running a scanner cane in millions cheaper than the private contractor. Guess who's now running the service? Yep, private

The problem here as I see it is the secrecy. Richard Branson is running a fair chunk of NHS services and so proud of the 'success' is he that he hides behind the NHS logo and patients are not aware that the ever deteriorating services are down to Virgin Care, not the good old health service.

I can see what is happening. Keep throwing money at NHS which still cannot cope with demand. Why? Because private providers charge more and keep more to pay shareholders. It's a win win for them and government supporters. The average guy on the street seeing his local hospital under strain wants an alternative. 'Private will do the job better' goes the cry from politicians when un reality private corporations are already sacking the life out of the system.

I recently needed a small operation for which I went to a private consultant purely for convenience. Whilst there it was found I needed a more serious operation for a related problem. The consultant decided it was to be done by her but in the NHS. The origional reason forth consultation would also be carried out by her but privately in the NHS hospital. Difference to me? It would have cost me over £2000 more had it been done in a private hospital even though it was the same surgeon.

Going the route we are we will end up like the US system. If the TTIP goes ahead, which no doubt it will, we will see costs rocket. Even treatment for minor ailments will be out of reach for most and insurance will also rocket more than it already has. Having had treatment in both nhsand private ( under employers insurance) I must say NHS every time. Having been the victim of post op problems following private surgery where was I shunted? Yep, to the NHS. No profit in putting their mistakes right.

The NHS is unlikely to survive the numbers of immigrants, legal EU, and illegal - Syria, Pakistan, Afghanistan, sub-Sharan Africa -all of whom will require urgent screening, and many will need treatment, some for long term conditions, not least of which will be psychological trauma . . . Many of whom will then have large families in accordance with their traditions . . .

There needs to be an urgent re-think, but by people with a totally open mind, not those who start by wanting to retain something that even in 1945 was unsustainable

We have to keep the NHS. Stop people from overseas using it without being billed. Their insurance papers should be seen before any op. is carried out on them. They do it in other countries so why not here?

Stop the prescribing of free bread, milk etc and all other stupid free prescriptions that are handed out.

Get CEOs and doctors' salaries - (gps and hospital staff), back to affordable levels.

We are often told that the massive salaries for management staff are needed because it attracts a better applicant and therefore management structure.

Errrr, if that is the case, why the heck is the NHS in such dire condition. Not just down to cuts, not by a long way.

In my view, still too many jobs for the boys. Cronyism and nepotism. Until this is eradicated then things can only get WORSE.

We have heard this "reasoning" re. bankers pay scales for years, but look at what happened there and is still happening. JOBS FOR THE BOYS. A recipe for disaster.

MERITOCRACY for me, but until the cronyism/nepotism inthe Lords and Commons is sorted, then there is no hope at all.

Leave the NHS alone. We paid our contributions and we want what we were promised. Anyone who has paid their dues deserves treatment of the highest order. It is out there, but is held back because too many are getting it who shouldn't be.

Since Thatcher the NHS has been undermined with the long term aim of privatisation, this is the neoliberal ideology... free markets will form balance. Pah, free markets are open to fundamental human greed and manipulation with short term gain and no thought or care for long term consequences for society as a whole or the environment. The only exception is the elite cronies who secure the futures of their family and gang through wealth and power accumulation. The MSM are on the side of and owned by part of the elites/establishment and have been feeding bias and propaganda for decades to tell the story of a failing NHS and have it sink into the nations consciousness.

Why are the private banks protected by the state but health and protection of the poor and low paid is being systematically dismantled? The state belongs to it's citizens... all of them, not one small sector. Anyone recall the banking crisis of 2008/9? Have banks been reined in since or are they still operating in the same way?

If you believe in free market economy then you will probably not believe in the fundamental principles that built the NHS and the welfare state, that's your choice but it is not mine. I believe we must have fundamental principles of fairness, basic rights and humanity and from that basis anything is possible if the WILL is there.